Madison Hospital
820 Third Avenue, Madison, MN 56256 · 135 Priced Procedures
Typical commercial prices here are 25% below the fair benchmark (0.75×) after accounting for local nurse/doctor wages and patient complexity.
Balances commercial hospital prices against CMS clinical safety, infection control, and patient experience.
Uniform Value Leader · Low-Cost Across Departments
Madison Hospital maintains low, disciplined commercial pricing across both routine shoppable procedures (0.6× Medicare, p50 0.74× Fair BaseRate) and emergency/ancillary services (0.9× Medicare, p75 0.93× Fair BaseRate). Both insured and self-pay patients benefit from below-benchmark rates across departments.
Where They're Good (Patient & Payer Edge)
- Elective shoppable care is priced 25% below peer Fair BaseRate (0.75×)
- Self-pay cash beats commercial insurance on 62% of shoppable procedures (98/100 Cash Honesty)
- CMS clinical safety score (69/100 safety score) with 72% patient recommendation
- IRS 501(c)(3) charity care provides free care up to 200% FPL and discounted care up to 400% FPL (53.4% AGB cap)
Where You Can Get Burned (Markup Traps)
- Even at low-cost facilities (0.75× Fair BaseRate), out-of-network or unnegotiated chargemaster bills can exceed commercial medians — confirm in-network status or request a self-pay cash quote up front.
- Captive ER (0.9×) & laboratory (1.1×) services average 1.50× higher multiples than routine shoppable care (0.6×)
- Upper-quartile procedures (Q75 0.93×) jump +26% above the median procedure ratio (Q50 0.74×)
- Unnegotiated chargemaster list prices average 6.3× Medicare (25¢ true HCRIS cost per $1 gross)
Pre-scheduled outpatient procedures where patients can comparison-shop.
Emergency, inpatient DRG, lab, and specialty drug lines billed after admission.
Detects median-gaming when upper-quartile codes spike above the p50 median.
Procedure Prices at Madison Hospital
High-impact clinical procedures (MRIs, surgeries, inpatient stays, visits) are prioritized first. Use the category pills or search bar to filter all 135 published procedures.
| Procedure & Billing Code | This Hospital | vs. Fair |
|---|---|---|
| Total knee replacement CPT Code: 27447 | $3,009 | 0.2× |
| C-section delivery (full package) CPT Code: 59510 | $2,192 | 0.7× |
| Vaginal delivery (full package) CPT Code: 59400 | $1,990 | 0.7× |
| Gallbladder removal (laparoscopic) CPT Code: 47562 | $1,517 | 0.2× |
| Trauma team activation HCPCS Code: G0390 | $845 | 0.6× |
| Blood transfusion CPT Code: 36430 | $816 | 1.6× |
| Bunion correction surgery CPT Code: 28296 | $631 | 0.2× |
| Sleep study (overnight, in lab) CPT Code: 95810 | $485 | 0.5× |
| Knee arthroscopy with meniscus repair CPT Code: 29881 | $492 | 0.1× |
| Cataract surgery with lens implant CPT Code: 66984 | $457 | 0.2× |
| Inguinal hernia repair CPT Code: 49505 | $467 | 0.1× |
| Breast lump removal CPT Code: 19120 | $452 | 0.1× |
| Colonoscopy with biopsy CPT Code: 45380 | $370 | 0.3× |
| Behavioral health residential care HCPCS Code: H0011 | $314 | 0.9× |
| X-ray, pelvis CPT Code: 72170 | $272 | 2.5× |
| Rabies immune globulin HCPCS Code: 90375 | $280 | 0.9× |
| Upper endoscopy with biopsy CPT Code: 43239 | $262 | 0.3× |
| Electrocardiogram (EKG, tracing only) CPT Code: 93005 | $200 | 3.1× |
| CT scan, abdomen and pelvis (with contrast) CPT Code: 74177 | $220 | 0.5× |
| Residential mental health treatment HCPCS Code: H2036 | $194 | 0.5× |
| MRI, brain (with and without contrast) CPT Code: 70553 | $218 | 0.4× |
| Colonoscopy (diagnostic) CPT Code: 45378 | $213 | 0.2× |
| Behavioral health assessment HCPCS Code: H0001 | $162 | 1.0× |
| Hepatitis B immune globulin HCPCS Code: 90371 | $140 | 0.9× |
| Psychiatric evaluation (first visit) CPT Code: 90791 | $149 | 0.8× |
Audit a Bill or Quote at Madison Hospital (Zero PHI Required)
Statutory 501(r) AGB Cap Limits Bill to $1,892
At 274% FPL (201%–400% FPL tier), 26 U.S.C. § 501(r)(5) caps FAP-eligible bills at Amounts Generally Billed (53.5% of gross = $1,892).
Self-Pay Cash Rate ($3,009) Beats Your Bill
Madison Hospital's published 45 CFR § 180 self-pay cash rate is $3,009 (vs. $3,009 commercial insurer median). Ask billing to reclassify the visit to prompt-pay self-pay if it beats your deductible.
Negotiate Toward $13,523 Fair BaseRate ($13,117 Medicare)
Your entered amount is at or below the modeled Fair BaseRate benchmark ($13,523).
Financial Assistance Policy (FAP) & Amounts Generally Billed (AGB)
Hospital-Specific CMS HCRIS Benchmark (53.5% of gross charges)
Under 26 U.S.C. § 501(r)(5), a tax-exempt hospital organization may not bill FAP-eligible patients more than Amounts Generally Billed (AGB) to individuals with insurance covering emergency or medically necessary care. Derived from this facility’s reported CMS HCRIS cost-to-charge & insurer allowance filings. Verify your exact Financial Assistance Policy (FAP) determination directly with the billing office.
Clinical Quality, Patient Experience & Infection Benchmarks
CMS Price Transparency Administrative Enforcement Log
Factual public administrative actions published by the Centers for Medicare & Medicaid Services regarding 45 CFR § 180 compliance at Madison Hospital. Prior administrative notices do not necessarily reflect current compliance status.
- 2025-02-13·administrative_or_closure
Closure Notice
Recorded - 2024-12-19·cap_corrective_action
CAP Request
Recorded - 2024-09-11·warning_notice
Warning Notice
Recorded
Source: CMS Hospital Care Compare. Clinical quality metrics summarize historical facility-wide cohorts and are not medical advice for individual care decisions.
How to Pay Less Nearby: Freestanding Centers, Insurer Leverage & Outpatient Savings
2D regional comparison of commercial negotiated price index against CMS clinical quality composite for Madison Hospital.
Verify the Raw Data: Official Hospital MRF, CMS Medicare.gov & Federal Filings
Safe-Harbor Data Corrections: Parsed directly from public 45 CFR § 180 hospital filings, CMS Care Compare, and CMS HCRIS cost reports. Hospital compliance officers may submit updated MRF URLs or rate tables for verification.